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Bioethics Group Admits that Half of ‘Brain Dead’ Patients Still Have Brain Function

Originally Published in LifeSite News on April 22, 2024. Read the original article here.

Written by: Heidi Klessig MD

 

On April 11, 2024, the National Catholic Bioethics Center (NCBC) issued a landmark position statement, acknowledging that at least half of patients diagnosed as ‘brain dead’ still have partial brain function. The NCBC statement was prompted by the 2023 updated guideline for the diagnosis of brain death published by the American Academy of Neurology (AAN) together with the American Academy of Pediatrics, the Child Neurology Society, and the Society of Critical Care Medicine.


According to the NCBC, the 2023 AAN updated guideline marks “a decisive breakdown in a shared understanding of brain death” and “a formal breach in a longstanding consensus in law and public policy” because this guideline does not conform to the current legal standard for brain death under the Uniform Determination of Death Act (UDDA). The UDDA requires the “irreversible cessation of all functions of the entire brain, including the brain stem.” But a part of the brain called the hypothalamus continues to provide neuroendocrine function in most patients declared brain dead. Is the hypothalamus important? According to the NCBC:


The hypothalamus can be understood as a kind of “smart” coordinating center in the brain which is involved in regulating temperature, salt-water balance, sex drive, and sleep. Recent studies show that it may play a role in phenomenal awareness and pain detection.


In particular, the NCBC criticized the 2023 AAN brain death guideline for instructing “that clinicians may declare patients brain dead despite evidence of neuroendocrine function. Because of this, the NCBC states:


Hypothalamic functioning shows that not all functions of the entire brain have ceased, as stipulated by the UDDA. Consequently, patients with confirmed hypothalamic function should not be diagnosed as brain dead, nor treated as dead, for the purpose of organ procurement.


The NCBC statement cited recent studies pointing out that neuroendocrine function (i.e. hypothalamic function) continues in 50-84% of patients diagnosed as brain dead. But it has long been known (at least since 1993) that the hypothalamus continues to function in brain dead patients. Every brain death guideline issued by the American Academy of Neurology (in 1995, 2010, and 2023) has stressed that brain death is a clinical diagnosis that requires only a bedside neurological examination. And even the 1995 guideline specifically mentions that brain death may be declared despite normal blood pressure and urine output, both of which are evidence of hypothalamic function. This is the same as saying (as per the 2023 AAN guideline) that clinicians may declare patients brain dead “despite evidence of neuroendocrine function.”


It has long been known (at least since 1993) that the hypothalamus continues to function in brain dead patients.


The current leadership of the NCBC deserves credit for this stunning admission given that, after decades of being a staunch supporter of brain death, the NCBC now acknowledges that half or more of brain dead patients still have brain function. For years, doctors have been dissecting still-living people to death for the sake of their organs!


However, the NCBC statement doesn’t go far enough because it continues to determine life or death on the basis of function: the function of the hypothalamus. Our humanness is not based upon our abilities or functions, but rather upon what we are. Every human person is a body-soul unity made in the image of God. Christianity, Judaism, Islam, and most other faith traditions define death as the separation of the God-given spirit (or soul) from the human body. A respect for the sanctity of human life demands that we be absolutely sure that the spirit has departed before pronouncing a person dead. Because the soul is immaterial, we do not have any human device to determine the exact moment of death when the soul departs. Therefore, as a safeguard against declaring death prematurely, the loss of heartbeat, breathing, and the passage of time have been used for millennia to be sure that the spirit has departed.


Awareness is a private, first-person experience, not accessible to an external observer.


Brain death advocates have asserted that when people become unconscious and completely dependent upon medical care, they are no longer persons and can be designated as dead. Again, this is assigning life or death on the basis of function. Moreover, doctors cannot know that these people are not inwardly aware. Awareness is a private, first-person experience, not accessible to an external observer. We have no tests for awareness, and can only test the patient’s level of arousal and ability to respond. Also, a condition known as cognitive-motor dissociation has been described in patients with brain injury, in which commands are understood by the patient, but the person is unable to respond as directed. And just because brain-injured people are ventilator-dependent, that does not mean that they are no longer persons, any more than people dependent on cardiac pacemakers are less than human.


‘Brain dead’ patients show every sign of life: their hearts beat, their cellular respiration continues, they digest food and excrete waste, they heal wounds, they can even deliver healthy babies. They may be very ill, and their prognosis may be death, but it is wrong to treat them as dead and plunder them for their organs while they are still sick and helpless.


Doctors, scientists, scholars, and philosophers have been vigorously debating the veracity of brain death for the last sixty years. Meanwhile, the public has been kept in the dark and fed propagandistic slogans such as “Give the gift of life.” Bioethicist David Rodriguez-Arias sums it up this way: “The history of death determination in the context of organ donation can be described as an indoctrinating attempt to settle a moral controversy [...].” And utilitarian philosopher Peter Singer has described brain death as “an ethical choice masquerading as a medical fact.”


People are not being given the information they need to give fully informed consent about what might be the biggest medical decision of their lives. And it’s even worse when you consider that many of these decisions are being made by minors, sixteen-year-olds who are getting their first driver’s license. Yet a recent medical article on brain death asserts, “Conversely, were all families to be made fully aware and truly informed, one would find very large numbers of people objecting, and that would create needless conflict and chaos.”


This recent admission by the NCBC shows that the public has been misled about brain death for too long. It is wrong and inhuman to label people as ‘brain dead’ and treat them as commodities. Everyone who has lost a loved one to organ harvesting should be outraged. Registered organ donors should revoke their donor status, and everyone should carry a refusal to donate card. Every state should pass legislation allowing people to opt out of a brain death determination for any reason. Brain death is not death, but a legal fiction, a way of removing civil rights from vulnerable, brain-injured people for the sake of their valuable, viable organs.

 

 

 

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